Ivabradine reduces myocardial stunning in patients with exercise-inducible ischaemia.

Ivabradine is an effective treatment for angina in patients with stable coronary artery disease (CAD) and for heart failure. Experiments in a canine model have shown that ivabradine reduces both acute left ventricular (LV) dysfunction and post-ischaemic stunning. Aim of this study was to investigate the effect of ivabradine on LV dysfunction and stunning in patients with CAD and exercise-inducible ischaemia. Fifteen patients with ejection fraction >40 % and heart rate >70 bpm were enrolled. After pharmacologic washout, echocardiography was performed at rest, at peak treadmill exercise and during recovery until return to baseline. After 2 weeks of ivabradine (7.5 mg bid) stress echocardiography was repeated at the same workload achieved during washout. Peak global and segmental (ischaemic vs. remote normal segments) LV longitudinal strain (LS) was assessed by 2D speckle tracking analysis. At washout, LS was significantly impaired in ischaemic compared to remote segments at peak stress and for several minutes during recovery. After ivabradine a smaller, albeit still significant, impairment of LS in ischaemic segments was observed at peak whilst no difference with remote segments was present during recovery. Furthermore, the average global LS value improved significantly after treatment. In conclusion, ivabradine reduces both acute LV dysfunction and stunning in patients with CAD and exercise-inducible ischaemia. We hypothesise that this mechanism might contribute to reduce chronic LV dysfunction in patients with CAD. In this setting the drug might limit the development of hibernating myocardium which is believed to result from repeated episodes of ischaemia and stunning.

Collateral presence and extent do not predict myocardial viability and ischemia in chronic total occlusions: A stress-CMR study.

BACKGROUND: Well-developed collaterals are assumed as a marker of viability and ischemia in chronic total occlusions (CTO). We aim to correlate viability and ischemia with collateral presence and extent in CTO patients by cardiac magnetic resonance (CMR). METHODS: Multicentre study of 150 CTO patients undergoing stress-CMR, including adenosine if normal systolic function, high-dose-dobutamine for patients with akinetic/>2 hypokinetic segments and EF ≥35%, otherwise low-dose-dobutamine (LDD); all patients underwent late gadolinium enhancement (LGE) imaging. Viability was defined as mean LGE transmurality ≤50% for adenosine, as functional improvement for dobutamine-stress-test, ischemia as ≥1.5 segments with perfusion defects outside the scar zone. RESULTS: Rentrop 3/CC 2 defined well-developed (WD, n = 74) vs poorly-developed collaterals (PD, n = 76). Viability was equally prevalent in WD vs PD: normo-functional myocardium with ≤50% LGE in 52% vs 58% segments, p = 0.76, functional improvement by LDD in 48% vs 52%, p = 0.12. Segments with none, 1-25%,26-50%,51-75% LGE showed viability by LDD in 90%,84%,81%,61% of cases, whilst in 12% if 76-100% LGE (p < 0.01). There was no difference in WD vs PD for ischemia presence (74% vs 75%, p = 0.99) and extent (2.7 vs 2.8 segments, p = 0.77). CONCLUSIONS: In a large cohort of CTO patients, presence and extent of collaterals did not predict viability and ischemia by stress-CMR. Scar extent up to 75% LGE was still associated with viability, whereas ischemia was undetectable in 25% of patients, suggesting that the assessment of CTO patients with CMR would lead to a more comprehensive evaluation of viability and ischemia to guide revascularization.

Validation therapy (VT) in nursing home: a case-control study.

VT is a method for communicating with elderly people with dementia. It has been applied since 2001 at the "Istituto Giovanni XXIII" in Bologna, a public trust, housing over 500 not self-sufficient elderly people. Around 75% of these subjects suffer from cognitive impairment, associated to behavioral and psychological symptoms of dementia (BPSD) in over 35%. To assess the effectiveness of VT, we carried out a study involving 50 subjects divided in two groups, of cases and controls, made up by 27 and 23 patients, respectively. In both groups neuropsychiatric inventory (NPI) and the Bedford Alzheimer nursing severity scale (BANSS) were used before the start and after the end of the study; the case group underwent both individual and group VT. The results show a marked decrease of the average NPI symptom score in the case group (from 22.0 to 9.5) vs. a rise in the control group (from 21.7 to 24.1). Agitation, apathy, irritability and nighttime behaviors were the most improved NPI items among the subjects who underwent the VT. In these patients also the NPI distress score turned out reduced, vs. a small increase in the control group. In the case group an improvement occurred with BANSS too, even if much slighter changes were registered vs. the control group. Although the small number of subjects enlisted does not allow to draw firm inferences, the study suggests that VT is able to reduce the severity and frequency of BPSD, thus improving the relationship with and the management of patients having diagnosis of dementia without any side effects.

[Idiopathic myelofibrosis. Radiological aspects of bone changes]. / Mielofibrosi idiopatica. Aspetti radiologici delle alterazioni ossee.

Idiopathic myelofibrosis is a chronic myeloproliferative disease characterized by skeletal lesions (30 to 70% of cases). We considered 49 patients with idiopathic myelofibrosis treated between 1972 and 1986 at the Institutes of Hematology and Radiotherapy, University of Bologna. Only 19 of these patients underwent roentgenographic skeletal surveys, associated with whole body bone scintigraphy in 4 cases, and with CT in 1 case. The most common bone change, as seen in 12 patients, was osteosclerosis, following two distinct patterns: pure, and mixed. Other types of bone involvement (osteoporosis and pure osteolysis) were seen in 2 cases only; in 5 patients radiological skeletal examinations did not show meaningful lesions. Conventional radiology is hardly ever conclusive in the diagnosis of idiopathic myelofibrosis. This is due partly to the often moderate degree of bone involvement, partly to the scanty specificity of the findings. However, a careful examination of the plain roentgenographs, completed when possible by other more recent imaging techniques, may be very important towards a more precise definition of the disease and, in some cases, for a correct diagnosis.

[Splenic irradiation in the treatment of idiopathic myelofibrosis. Retrospective study of 14 cases]. / L'irradiazione splenica nel trattamento della mielofibrosi idiopatica. Studio retrospettivo di 14 casi.

A retrospective study was conducted on 14 patients with idiopathic myelofibrosis after splenic irradiation in order to cure the symptoms due to secondary splenomegaly. Radiation dose ranged from 700 to 2400 cGy, depending on both clinical response and hematological toxicity. Relief of symptoms was observed in all patients (100%); reduction of splenic size ranged from 30 to 70%, with more than 50% reduction in 13/16 cases. Side effects were mild neutropenia and thrombocytopenia, which did not require interruption of treatment; four patients registered a severe anemia. All the hematological side effects stopped with the suspension of treatment. This study shows the beneficial effect of radiation therapy on the symptoms connected to splenomegaly; however, the short duration of response suggests the advantage of splenic low-dose irradiation, to be periodically repeated.

[Femoral osteonecrosis in patients treated with radiochemotherapy of Hodgkin's lymphoma]. / Osteonecrosi femorale in pazienti trattati con radio-chemioterapia per linfoma di Hodgkin.

Therapeutic progress has much improved the prognosis of Hodgkin's disease; therefore long-term complications of the treatment have become a major problem. Among these, the authors focused on osteonecrosis of the femoral head, and conducted a retrospective study on 182 patients treated with inverted-Y-field radiation therapy combined to MOPP chemotherapy in 129 cases. Femoral osteonecrosis was found in 6 patients (3.3%), 5 males and 1 female; 4 of them received combined modality treatment (inverted-Y radiation therapy + MOPP), and 2 radiation therapy alone. The interval between the end of treatment and the radiological finding of femoral osteonecrosis ranged from 23 to 54 months, with a mean of 35 months. On the whole, 10 cases of osteonecrosis of the femoral head (4 bilateral, and 2 unilateral) were observed, and 4 fractures involving the anatomic neck. According to our results, neither a safety dose-limit nor an optimal schedule of combination therapy could be fixed. Besides radiological features and the problems of differential diagnosis, the authors considered the pathogenesis of femoral head osteonecrosis in the patients with Hodgkin's disease treated with radiotherapy alone or combined to chemotherapy, and suggested the existence of a personal proneness to the lesion and the role of ionizing radiations, corticosteroids and cytotoxic agents, as inducing factors. Because of the different and unexpected reaction of each patient to the treatment, osteonecrosis prevention is very difficult: however, its complication may be reduced--or even avoided--by subjecting the treated patients to periodic clinical and radiological examinations.